Zakane S Alphonse, Gustafsson Lars L, Sie Ali, Tomson Göran, Loukanova Svetla, Bastholm-Rahmner Pia
1. Centre de Recherche en Santé de Nouna, BP 02 Nouna, Burkina Faso.
2. Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet at Karolinska University Hospital , SE-141 86, Stockholm, Sweden.
Online J Public Health Inform. 2017 Sep 8;9(2):e188. doi: 10.5210/ojphi.v9i2.7905. eCollection 2017.
Maternal and neonatal mortality is high in sub-Saharan Africa. To support Healthcare Workers (HCWs), a computerized decision support system (CDSS) was piloted at six rural maternal care units in Burkina Faso. During the two years of the study period, it was apparent from reports that the CDSS was not used regularly in clinical practice. This study aimed to explore the reasons why HCWs failed to use the CDSS.
A workshop, organized as group discussions and a plenary session, was performed with 13 participants to understand their experience with the CDSS and suggest improvements if pertinent. Workshop transcripts were analyzed thematically. Socio-demographic and usage patterns of the CDSS were examined by a questionnaire and analyzed descriptively.
The participants reported that the contextual basic conditions for using the CDSS were not fulfilled. These included unreliable power supply, none user-friendly partograph, the CDSS was not integrated with workflow and staff lacked motivational incentives. Despite these limitations, the HCWs reported learning benefits from guidance and alerts in the CDSS. Using the CDSS enabled them to discover problems earlier as they learned to focus on symptoms to prevent harmful situations.
The CDSS was not tailored to the needs and context of the users. The HCWs, defined their needs and suggested how the CDSS should be re-designed. This suggests that the successful and regular usage of any CDSS in rural settings requires the involvement of users throughout the construction and pilot-testing phases and not only during the early prototype design period.
撒哈拉以南非洲地区的孕产妇和新生儿死亡率很高。为了支持医护人员（HCWs），在布基纳法索的六个农村孕产妇护理单位试点了一个计算机化决策支持系统（CDSS）。在为期两年的研究期间，从报告中可以明显看出，CDSS在临床实践中并未得到定期使用。本研究旨在探讨医护人员未使用CDSS的原因。
举办了一次研讨会，以小组讨论和全体会议的形式进行，有13名参与者参加，以了解他们使用CDSS的经验，并在相关时提出改进建议。对研讨会记录进行了主题分析。通过问卷调查对CDSS的社会人口统计学和使用模式进行了调查，并进行了描述性分析。
参与者报告说，使用CDSS的背景基本条件未得到满足。这些条件包括电力供应不可靠、产程图不便于用户使用、CDSS未与工作流程整合以及工作人员缺乏激励措施。尽管存在这些限制，医护人员报告称从CDSS中的指导和警报中获得了学习益处。使用CDSS使他们能够更早地发现问题，因为他们学会了关注症状以预防有害情况。
CDSS未根据用户的需求和背景进行定制。医护人员明确了他们的需求，并建议了应如何重新设计CDSS。这表明，在农村地区成功且定期使用任何CDSS需要用户在整个建设和试点测试阶段参与，而不仅仅是在早期原型设计阶段。
